PRACTICE STANDARDS FOR NEUROFEEDBACK: A POSITION PAPER OF THE INTERNATIONAL SOCIETY FOR NEUROFEEDBACK AND RESEARCH

PRACTICE STANDARDS FOR NEUROFEEDBACK: A POSITION PAPER OF THE INTERNATIONAL SOCIETY FOR NEUROFEEDBACK AND RESEARCH

ORIGINAL PUBLICATION D. Corydon Hammond, Genie Bodenhamer-Davis, Gerald Gluck, Deborah Stokes, Sara Hunt Harper, David Trudeau, Margaret MacDonald, Joy Lunt, & Lynda Kirk (2011). Standards of practice for neurofeedback and neurotherapy: A position paper of the International Society for Neurofeedback & Research, Journal of Neurotherapy, 15(1), 54-64. To link to this article: http://dx.doi.org/10.1080/10874208.2010.545760

PURPOSE These guidelines are intended to provide a reference for professionals and the public on basic methods for the delivery of neurofeedback (EEG biofeedback)

THE DEFINITION OF NEUROFEEDBACK Neurofeedback involves placing sensors on the scalp, and by means of electronic instrumentation, recording the electrical activity of the brain. This activity is presented back to the individual, by means of computer displays, videogames, and soundtracks, such that changes in display indicate changes in brain state.

THE DEFINITION OF NEUROFEEDBACK This feedback enables the individual to change brain function. The means in which the signal is displayed and controlled is the responsibility of the neurofeedback practitioner, and should be carried out in accord with the following guidelines.

THE PRACTICE OF NEUROFEEDBACK Neurofeedback developed as a multi-disciplinary modality It is practiced by wide variety of providers from various disciplines, not all licensed healthcare providers The range of neurofeedback applications includes: Assessment and treatment of conditions diagnosed by licensed healthcare providers, Training for optimal performance (athletes, executives, students, performing artists, and other healthy individuals), and Clinical and applied scientific research.

TRAINING AND CREDENTIALS FOR NEUROFEEDBACK PRACTITIONERS Membership in ISNR and certification by BCIA demonstrate to the public that a provider is able to provide ethical and competent training. When a professional treats a diagnosed mental or other health condition, it is recommended that the provider be a licensed healthcare provider, and that the provider s scope of practice include assessment and treatment of this condition.

PRACTICE GUIDELINES Follow the ethical principles of ISNR and any other professional organization to which one belongs. Accurately represent one s training, professional qualifications, and/or licenses, and disclose relevant limitations. Provide neurofeedback training only for those problems or goals for which one is competent, as demonstrated by training, experience, licensure or supervision.

GUIDELINES (CONT.) Provide neurofeedback (NFB) training for diagnosed medical or mental conditions only if one is a licensed healthcare practitioner, with a scope of practice and competence including these conditions. When an unlicensed NFB provider assesses a client and the severity/complexity of the disorder suggests a diagnosable problem, then it is recommended that the NFB provider discuss this with the client, review the limits of their practice, and encourage the client to consult with their physician or licensed healthcare provider.

GUIDELINES (CONT.) Maintain competency through continuing education. Seek consultation and supervision for cases in order to assure oneself and the client that training is in keeping with current standards. Document the client s consent to the specifics of training, including where and how the client will be touched, acknowledgement of training benefits, risks, and costs. Accurately represent the degree of scientific support in peer-reviewed publications for NFB assessment and training for the presenting problem.

GUIDELINES (CONT.) If technicians are used, document the client s understanding of the technician s qualifications, role, and degree of supervision. Document the client s consent for their data to be used for research and/or educational purposes, if applicable. Document the client s acknowledgement of the limits of confidentiality. Document the client s acknowledgement that training will not necessarily achieve agreed upon goals, either completely or at all.

GUIDELINES (CONT.) Document the client s acknowledgement that unexpected changes in the client s experience or behavior may occur during course of training. It is important for the client to inform the NFB provider, so that training methods can be adjusted or discontinued, if necessary, and the unexpected changes can be addressed. Provide training regardless of race, creed, color, nationality, gender, sexual orientation, religioon, or social affiliation.

GUIDELINES (CONT.) Collaborate with clients to develop measurable training goals, a clear plan for training, and methods for measuring progress toward goals. This collaboration should include regular review of progress, with the objective of asking for client s decision on whether the benefits of continued training merits the cost. Carry out effective practices for maintaining good hygiene, applying electrodes, and establishing adequate electrical connection. Maintain software and hardware in good and up-to-date condition.

GUIDELINES (CONT.) Use hardware and software that is safe, accurate, and effective for the purpose to which it is applied. Equipment which meets the IEEE (Institute of Electrical and Electronics Engineers) or which has been FDA registered is recommended. Plan and carry out NFB training that is based on scientificically validated principles and methods. Plan and carry out an organized course of neurofeedback that is adequate for the presenting problem and goal, including a pre-training EEG assessment.

GUIDELINES (CONT.) Provide therapeutic support, coaching, and direct supervision during client NFB training, sufficient to achieve agreed upon goals. Document the client s understanding of the degree to which the trainer will be present during training.

GUIDELINES FOR REMOTE OR HOME TRAINING Carefully assess and document the benefits, risks, and abilities of the person who may conduct remote or home training. Home training should be discouraged for conditions with a clinical diagnosis. Careful attention must be given to training and supervising the person conducting the sessions at the home. Full disclosure and informed consent of potential problems should be given, and instructions on how and when to report them.

GUIDELINES FOR REMOTE OR HOME TRAINING (CONT.) Methods to resolve potential problems should be discussed, and the client s understanding documented with a signature. Steps to prevent or limit the use of NFB software and hardware beyond their intended purpose should be documented. The issues of performing services outside of one s geographic region of license or certification must be taken into consideration.